Correcting ectopic ureters in juvenile dogs

Correcting ectopic ureters in juvenile dogs

Cystoscopic-guided laser ablation is a minimally invasive alternative to surgery
May 01, 2011

Ectopic ureters are a congenital anomaly of the urinary system, in which the ureteral orifice is inappropriately positioned caudal to the urinary bladder. This is the most common cause of urinary incontinence in juvenile female dogs. See how the use of cystoscopic-guided laser ablation provides a minimally invasive alternative to surgery in cases with intramural ectopic ureters, as was seen in this Golden Retriever puppy.

Initial findings

  • Signalment: 4-month-old intact female Golden Retriever
  • Presenting complaint: Owner is unable to housetrain; urine staining around hind end
  • Pertinent history: Always wet around back end; bad-smelling urine; urine culture results positive for Escherichia coli that is sensitive to amoxicillin-clavulanic acid; with treatment, odor resolved, but incontinence persisted
  • Medications: Amoxicillin-clavulanic acid (15 mg/kg orally b.i.d.), phenylpropanolamine (1.5 mg/kg orally t.i.d.)
  • Physical examination findings: Bright, alert, good body condition; urine staining around fur of tail, vulva and medial aspect of both hindlimbs; slightly recessed vulva; normal neurologic examination with good anal tone. The remainder of the examination was within normal limits. Rectal examination palpated a wide urethra with evidence of the bladder neck at the level of the pubis.

Diagnostic evaluation

  • Blood pressure: 130 mm Hg systolic
  • Complete blood count: Slight normochromic normocytic nonregenerative anemia of 33 percent
  • Serum chemistry profile: BUN 13, creatinine 0.4, phosphorus 12
  • Urinalysis: USG 1.021, no white blood cells, no red blood cells/hpf, no crystals, no bacteria, pH 6.5
  • Urine culture: Negative (while still receiving amoxicillin-clavulanic acid)
  • Abdominal radiography: Within normal limits
  • Abdominal ultrasonography: Loss of architecture to both kidneys; minimal pyelectasia (2.5 mm) bilaterally; empty bladder, unable to perform cystocentesis

Figure 1: Endoscopic images of a dog with ectopic ureters. The dog is in dorsal recumbency during a cystourethroscopy. A) The left ectopic ureteral opening is visualized inside the urethral lumen (yellow asterisk). B) An open-ended ureteral catheter is placed inside the ectopic ureteral lumen (black arrow). C) A diode laser (red arrow) is cutting the medial ureteral wall over the ureteral catheter (black arrow) to advance up the neo-ureteral orifi ce to the bladder lumen. D) The neo-ureteral orifi ce is now inside the urinary bladder lumen (yellow asterisk). A guidewire (black arrow) is still inside the ureteral lumen.
Cystoscopy: See Figure 1

Figure 2: A fl uoroscopic image of a dog during retrograde ureteropyelography and concurrent cystourethrography. The bladder is fi lled with contrast material. The rigid cystoscopy is at the level of the bladder trigone, and a guidewire is inside the ureteral lumen coursing through the intramural tunnel and then transitions extramurally beyond the bladder trigone.
Retrograde ureteropyelography: See Figure 2

Figure 3 (far right photo): Endoscopic images with the dog in dorsal recumbency after the cystoscopic-guided laser ablation procedure. The top image shows a thick vaginal band (persistent paramesonephric remnant) pulling the urethral orifi ce open. This band splits the vaginal opening into two compartments. The middle image is the remnant of the vaginal band after it is laser-ablated with a diode laser. This band went all the way back to the cervix and was completely cut down with the laser to the level of the cervix seen here. The bottom image is the vaginal (bottom) and urethral orifi ce (top) after thepersistent paramesonephric remnant is lasered open showing an open vagina.
Vaginoscopy: See Figure 3